1952381261 NPI number — DR. JOSEPH LAWRENCE GIMMARRO JR. D.M.D

Table of content: ASHLEY MARTINELLI (NPI 1952821589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952381261 NPI number — DR. JOSEPH LAWRENCE GIMMARRO JR. D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIMMARRO
Provider First Name:
JOSEPH
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952381261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2018 HUNTERS CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUPERIOR TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48198-9610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-485-8469
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 N CANTON CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48187-5065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-981-8040
Provider Business Practice Location Address Fax Number:
734-981-6432
Provider Enumeration Date:
01/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  14625 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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